HomeMy WebLinkAbout0076 WASHINGTON AVENUE - Health k t
76 Washy hi
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287=096 Hyannis': ,
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COMMOTwe'aith o ?6ssachuse##s.
u1 W1
f� Title -Official o Forte
_I m ,--,;/1c; Subsurface Seviage Dosposal System Forma Not for Voluntary Assessments'
ate .
ra
../ 76 WASHINGTON AVE
Property Address
JOE SHAY
Owner Owner's Name
information is HYANNIS PORT MA 02647 8/24/2009
required for every
page. : City/Town T State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered.in any
way.
Important:When
filling out forms ro General Information
on the computer,
use only the tab
. -C/
_r- ____key to move your 1. Inspector
cursor-do not JAMES DSEARS
use the return '
keY
Name of Inspector-
BLUEWATER
VQCompany Name
350 MAIN ST:
Company Address-
W..YARMOUTH MA. - 02673.
Cityrrown States
Zip Code;,
508-775-2800 S-1623
Telephone Number License Number
B. Cert Catjo»
I:certify that I have personally inspected.the sewage disposal system at this address and thatthe
information reported below is..true, accurate and complete as of the time of the inspection. The inspection
was performed based oa.rny_training and.experience in the proper function and maintenance of on site
sewage disposal systems.:I am.a DEP approved system inspector pursuant to Section 95.340 of..
Title 5(3-0 CM 35;9C®)the system:
® Passes ❑ Conditionally Passes
❑ Needs Further Evaluation by the Local Approving Authority o� �r�c
JAMES '
0: SEARS :y=
/�' J 8/25/2009
�.A- ��
T'• . RTi � �O
nspector'sSignature Date
�A
The.system inspector shall submit copy of this inspection,report to the Approving Authority (Board
of.Health,or DEP)within 30'days of completing'this inspection..'If the system.is a shared system or
has'a design-flow of 10;000 gpd or'greater, the inspector and the system owner shal_submit the
report tothe appropriate regional office of the.DEP. The original should be sent.to the,system owner
and copies sent to the buyer,if applicable, and the approving authority:
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform' in the future under
the same or different conditions of use.
76 wASHINGTON AVE HYANNISPORTdec•03/08 Title 5 Official.lnspection Form:Subsurface SewaIDsal System•Page 1 of 16
.,\ Commonwealth of a$sAchusatt
� I Title 5 Off Iclaf Inspection Forte
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�y 7o VVASHINGTON AVE
` Property Address
JOE SHAY
Owner Owner's Name
information is HYANNIS PORT MA 02647 8/24/2009,
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cone.) Y
Inspection Summary: Check A,B,C,D or E/alwayscomplete all of.Section D
A)f System Passes: X
- -- - - P ❑ 1,have not found any,information which indicates that.any of the failure criteria described--- -- -
in 310 CIVIR 1.5.303,'or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.=:
Comments:
B) System Conditionally.Passes:
El ° One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon'completion of the replacement'or repair, as approved `.
by the Board.of Health,will pass:
Answer yes,:no"or not determined (Y, N,'ND) in the❑for the following statements. If"not
determined, please explain
❑ Toe"•septic,tank is metal and over 20 years old`or.the septic tank{whether metal or,not),is
structurally,,unsound; exhibits substantial infiltration or.exfiltration or tank failure is imminent. ;
System will pass inspection if.the existing tank is replaced with.a complying septic tank as.
approved,.by the Board of Health.
-- -
"A rrretarseptic tank wi_ILI_passirrspection_ifiit s_structurally_soand not teakirrg and_f a
n
Certificate of:Compliance indicating,that the tank is less than 20 years old is available:
,
ND'Explaln .
❑ Observation of sewage backup or break out or high static water level in the distribution box
due to brokznor obstructed pipe(s) or due to a broken, settled or uneven distribution-box: System will
pass inspection.if(with approval of Board of Health):
❑ -broken pipes) are replaced
❑ obstruction Is removed' '
76 WAS HINGTON AVE MAN NISP0 RT.doc 03/08 Title-5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 1.5
Commonwealth of Massachusetts
_,
^F Title :Official Forte
1 Sta'bsurface Sep rage Disposal yslem Form m Notfor.Voluntary Assessments
76 VVASHINGTON AVE
Property Address
JOE SHAY
Owner Owner's Name
information is HYANNIS PORT - MA 02647 8/24/2009
required for every
page. City/Town State Zip Code Date of Inspection
Bo, Certification (cont.)
B) System Conditionally Passes(cone.):
distribution box.is.leveled or..replaced
ND Explain: :.
❑ The system'required pumping more than 4°times a year-due to broken or,obstructed pipe(s).
The system will pass inspection if(with approval of the Board of Health):
broken;.pipe(s) are.replaced
❑ obstruction is removed
ND Explain: ,
C) Further Evaluatibri is Required by the Board of Health:,
❑ Conditions exist which require further evaluation,bythe Board of Health in order,to determine
if the system is failing to protect public health, safety or the environment.
I.::System will,pass unless Board of Health deterfnines in accordance with 310 CMR
18.303(1)(b),that,the system is not functioning in a.rmanner which will rotect,public t
health, safety and the.eriviron ment: ,.
❑ Cesspool or privy is within 50 feet of a surface water .
_ Cesspool`or privy_is wiithin...50-feet.of a bordering vegetated.-wetland_or aaatt_marsh
2. Syst r �N�ll fail um3ess tfae Board of Heaatn:Qabd Publio��0ater Saapp93er, if,any)
determines that the systern is functioning in a mariner that protects the public health,
safety and environment; .,
❑ " , 'The system has a septic tank and'soil absorption system (SAS) and the`SAS is-within
-100 feet of a surface water supply or tributary to'a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public
water-supply. ,
❑. The system has a septic'tank and SAS and the SAS-is"within 50 feet of a private
watersupply.welL 4;
76 WASHINGTON:AVE:HYANNISPORT.doc•03/O8, Ttle 5 Offcial'Inspechen Form;Subsurface Sewage Disposal System .Page,3 of 15
>t Commonvisalth of Massachusetts
Title 5 Official Ins pa*ction- For
_ -
fcI Subsurface Se.rjage Disposal System Foram, Not for Voluntary Assessments
76 WASHINGTON AVE
` Property Address
JOE SHAY
Owner Owner's Name :
inform
requirede
gar every HYANNIS PORT MA 02647 8/24/2009
required
page. City/Town -.state _ Zip Code Date of Inspection
IS. Certification (coat.)
C) Further Evaluation is Required by the Board of.Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or..
more from.a private water supply wells".
Method,used to determine
distance:
**This system passes if the'well water analysis, performed at a DER certified laboratory,.for coliforim
bacteria indicates absent and:the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than:5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached;to.this form. ;..
3. Other:
D). System Failure Criteria Applicable to All Systems: .
You must i�dlcate "Yes"or."No".to each, of the followiving for all inspections:
Yes No :
0 Backup of sewage into facility or system.component due to overloaded or
clogged-SAS cir_eesspoof
Discharge or ponding—of effluent to the surface of-the ground or surface waters
due to an overloaded or.clogged SAS or cesspool
0 Static liquid level in the distribution box above outlet invert due to an overloaded
- or clogged SAS or cesspool -
0 Liquid'depth in leaching is less than 6" below invert or available volume is less
thari'h day flow
® : Required pumping more than 4 times in the last year NOT due to clogged or.
obstructed pipe(s). Number of times pumped:
Any.portion of the SAS,cesspool or privy is below high.ground water elevation._
. Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a-surface water supply.
76 WASHINGTON AVE HYANNISPORT.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.-Page 4 of 15
COMMonylealth 'Of Nlassachusett
1 �= Title 5 Official InspectIOnr FOM-
(, Sabsu�;acs Sewage Disposal Systsr a Form Not for Voluntary Assessments.
" Y; 76 V\/ASHIi\1G T ON AVE
Property Address
JOE SHAY
Owner Owner's Name
information is required for every HYANNIS PORT MA 02647 8/24/2009
page. City/Town State Zip Code:` Date of Inspection` .
B. Certification (cont:)
D). System, Failure Criteria Applicable to All Systems (cont.):
. Yes No
❑ Any portion of a cesspool or privy is within a Zone 1 of a public well: .
- -_0 --- :❑ - Any portion,of a cesspool or privy,is within 50-feet-of7a private water,supply well
❑ 7 Any portion'of a cesspool:or privy is less than 100 feet but greater`than 50'feet
from a private water supply well with no acceptable water quality analysis. (This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia aaltrogen and nitrate,nitrogen is equal to or less than 5 Ippirn,
'Provided that no other failure criteria,are triggered.. A copy of the analysis'
and chain of custody must be attached to this forma '
G The system is a cesspool serving a facility with a design flow of 2000gpd-.
10,000gpd.
❑ 0. The system fails. l have determined that one or more of the above failure,.
criteria exist as described in 310 CMR 15:303,,therefore the system falls.The
System owner should contact the Board of Health to determine what will be.'
necessary to'correct.the failure. .
a
E) Large,Systcros: To be considered a large system the system must serve a facility with a
design flow of 10,000.gpd to 15,000 gpd,
For__lar_ge-systems,--you-must_indicate_either"yesl' or"no"to_each of_the follo_wmg, i.n`addition-to the
questions in"Section D.
w
Yes` >No
❑. ❑ the,system is within 400 feet of a surface drinking /ater supply
El -El the system,is within 200 feet of a tributary to a surface drinking water supply.
the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area IWPA) or a mapped Zone 11 of a public water supply well
If you have answered "yes"_to any question in Section E the system is considered a<significant threat,
or answered "yes"'in Section D above the large system has failed. The owner or operator of any large
system-:considered:a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department:
76 WASHINGTON AVE HYANNISPORT.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System=Page 5 of 15
Commonwealth of Massachusetts
1,711
Official
- Title 5
_I I Subsurface Seviage Disposal System
—Plot for Volun#ark Assessments
` 76 WASHINGTON AVE
Property Address.
JOE SHAY
Owner Owner's Name
information is required for every HYANNIS PORT MA 02647 8/24/2009
page. City/Town State Zip Code Date of Inspection
Checklist
Check if the following have been done. You must indicate"yes" or'no" as to each of the following.
Yes No
❑. Pumping information wasprovided.by the owner, occupant,or Board of'Health
- - ❑— = - -Were any=of the system components pumped out in the previous-two weeks? -
0 ❑ Has the system received normal flows in the previous.two week period?
0 Have large volumes of water been introduced to the system recently or as part of
this inspection?
0 Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
4 ❑ "Was the facility or dwelling inspected for signs.;of sewage back up?
; Was the site inspected for signs of break out? .
�, . ❑ Were all System.components, including the SAS, located on site?
❑; Q` Were'the septic tank manholes uncovered, opened; and the interior of the tank
f inspected far the condition of the baffles or tees, material of construction,.,,
dimensions,'.depth of liquid,.depth of sludge and depth of scum?
0 Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewagedisposal systems?
The size grad location of the.Soil Absorption System (SAS)on'the site has
been determined based on:
® : ❑ Existing information: For example, a plan at the Board of Health.
❑ ' O
Determined in the field (if any of the failure criteria related.to Part Gis at issue.
approximation of distance is unacceptable) [310 CMR 15.302(5)]
76 WASHINGTON AVE HYANNISPORTdcc•03108 Title 5 Official Inspection Farm:Subsurface Sewage,Disposal System•Page 6 of 15
Commonwealth of Mass.achuse#t.�
]a ns is
rr .
ubsu Faoe Seviage Disposal Sys
Mm Form - Not for Voluntary Assessments
Y
76 WASHINGTON AVE
Property Address
JOE SHAY
Owner Owner's Name
information is required for every HYANNIS PORT MA 02647 8/24/2009
page. City/Town State Zip Code Date of Inspection
D. System Informatlon
Residential Flow Conditions:
Number of bedrooms (design): 7 Number of bedrooms (factual). 770
DESIGN flow based on 310.CMR.15.203 (for example: 110 gpd x#of bedrooms): 5
Number of current residents �
4
Does residence have a garbage grinder? ❑Yes x❑ No
Is laundry on a.separate sewage system?[if yes separate inspection required] ❑Yes No
Laundry system inspected? . . . ❑Yes 'No'
`'Seasonal use? .: . E]Yes Z . 'No
Water{meter readings, if available last 2 ears usage d NA
g ( Y 9 (gP ))�
Sump pump? []Yes 'No
CURRENT .
. Last date of occupancy: r
v _ Date.
Coniinee°c al/lndustriai•PIolliConditisns
Type of'.Establishment:
-- -Design flow-(based-on 31-9 CMR-5-203.)— — --- — ----- -
Gallons per day(gpd) ,
Basis of design flow(seats/persons/sgfft.;,etc.).
Grease trap presents ❑Yes ❑ No-
Industrial waste holding tank present? ❑Yes; No
Non-sanitary waste discharged to the Title 5 system? [I Yes ❑ .No
t Water meter`readings, if available.
Last date of occupancy/use:
Date.
Other(describe):
.76 WASHINGTON AVE HYANNISPORTdoc-,03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7''of 15.
Commonwealth oil Massachusetts-'
9 Title-5ffidal Ins coo Forte,
1 Subsurfade S,eviage Disposal System Form -Not for Voluntary Assessments
76 WASHINGTON AVE
Property Address
JOE SHAY
Owner Owner's Name
information.is required for every HYANNIS PORT MA 02647 8/24/2009
page. Cityfrown State Zip Code Date of Inspection
D. System Information (coat.)
General Information
Pumping Records
Source of information: 2008
Was system pumped as part of the inspection? - - ❑Yes -, No---
If yes, volume pumped: : ..
gallons
How was quantity pumped determined?
Redson for pumping
Type of.SysteM:.',
Septic tank, distribution box, soil absorption system
❑
Single cesspool
9 p
❑` .Overflow cesspool 4.
P'
t
❑; Privy
❑ Shared system(yes or no) (lf- es,attach previous inspection records If any)
--_ — __-- ❑ = ilnnovative/Alternative-techhology.-Attach a copyof=the current operatlorrand —
maintenance contract(to be obtained from system.owner)and a copy of latest
inspection of the l/A system by system.operator under contract
F. Tight ank, Attach a copy of the DEP approval.
Other(describe):
Approximate age of all components,date installed (if known) and source of:information:..
1997 PERMIT#`97-273
Were sewage odors detected when arriving at the site? []Yes. No
-76 WASHINGTON AVE HYANNISPORTclbc•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15
: .. Commonwealth of Massachusetts
o.
I:, Subsurface Selivage Disposal System Form - Not for Voluntary.Assessments
,_7
-° 76 WASHINGTON AVE
Propetj Address
JOE SHAY
Owner Owner's Name
information is HYANNIS PORT ' MA 02647 8/24/2009
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (coat)
Building Sewer(locate on,.site plan):
Depth below grade: feet
feat
Material of construction:
''cast iron--- s 0 40 PVC w: ❑ other(explain): ;
Distance from private water supply well`or suction line:
feet
Comments.(on condition of joints, venting, evidence of leakage, etc,.):
'CAMERA LINES CLEAN &SOLID
Septic Tank(locate on site plan)' -
Depth below grade::
feet
Material of construction:
Z concrete ❑ metal. ❑ fiberglass D polyethylene , ❑ other(explain)-
If tank is.metal,list age`.
years
-- --. Is age confirmed by=a Certificate-of Compliance? (attach a=cony of certificate} QYes- No.-:
Dimensions:, 42000 GAL PRE CAST'
Sludge depth 2911
..
Distance from top of sludge to bottom of outiet.tee or baffle
:,.
Scum thickness
Distance from top of scum to top of outlet tee or,baffie.` $
17"
Distance from bottom of scum to bottom1of outlet tee or baffle
How were.dimensions determined?.-: TAPE-PLAN-SLUDGE JUDGE
0
76 WASHINGTON AVE HYANNISPORT.dcc•03108 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System Page 9 of 15
r
E
Commonwealth of Massachusetts
T -
,
j Subs'Llrface sewage Disposal System Form.m Not for Voluntary ASSes�MentS
_,�
76 WASH I NGTONAVE
Property Address
JOE SHAY
Owner Owner's Name
information is required for every HYANNIS PORT MA' 02647 8/24/2009
,
page.. City/Town State Zip Code Date of Inspection
D.System Information (cone.)
Comments (on pumping recommendations, inlet and outlet tee.or baffle condition, structural integrity,
liquid levels as related to.outlet invert, evidence of leakage, etc.):
TANK AT WORKING LEVEL. TANK*OUTLET AT 16". INLET COVER AT 4".,OUTLET TEE. NO
SIGN OF OVERLOADING OR SOLID CARRY OVER.
Grease Trap (locate on site plan):
'Depth,belowgrade:
feet
Material of construction: a
❑ concrete ` ❑ metal ' ❑ fiberglass El polyethylene ❑ other(explain) °
Dimensions:
Scum'thickness _ .
Distance from top ofscum to-top oT outlet tee or baffle
r
Distance from bottom of scum to'bottom of outlet tee or-baffle
Date—of Fast;:pumping:
--- --- --- ---
Date ,
Comments.-(on pumping recommendations, inlet and outlet tee or baffle_condition, structural integrity,.
liquid levels as related to outlet invert, evidence of leakage, etc.):`
Tight or�8olsi'st�g Tank(tank must be pumpedi at time of inspection) (locate on site plan):
Depth belowgrade:
Material of construction:
❑ concrete ❑ metal El.fiberglass ❑ polyethylene 0 other.(explain):
76 V1.ASHINGTON AVE.HYANNISPORT.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Y Page 10 of 15
` Commonwealth of Massachusetts
Forte
Subsuff Se�i��age Disposal System Form Not for Voluntary Assessments
ji,
76 WASKNIGTON AVE
Property Address
JOE SHAY.
Owner Owner's Name
requiratifore HYANNIS PORT MA 02647 8/24/2009 -
required for every
page. City/Town State Zip Code Date.of Inspection
D. Systems Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:,
Capacity:
gallons
Design Flow:,
gallons per day
Alarm present. []Yes No
Alarm level:• Alarm in working order: ❑ Yes El No
. - o"Date r la' st pumping:
a
Date
Comments (condition of alarm and.float switches, etc.): . '
*Attach copy of current pumping c ntract (required). Is co attached? ❑ •Yes ❑: No
. ,. pl P p 9 R ,copy
Distribution Box (if present must be opened) (locate on site plan):
Depth.of liquid level above-outlet invert 0
—--Comments.-(hole iftax Is-Level ancf distribut on-to outlets equaC,—any evidence of solids carryover,, any
evidence of leafage info or out.of box, etc.):
DISTRIBUTION'BOX IS ZXZ-30".BELOW GRADE.`BOX IS CLEAN &SOLID:NO SIGN OF OVER
LOADING OR SOLID CARRY OVER:
Pair p Chamber—(locate on site plan): .
❑Pumps in working.order: l Yes ❑ No
. I
Alarms.in working order: ❑Yes No
75 WASHINGTON AVE HYANNISPORT.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
< � Commonwealth of�raasc Uat#s
RI
{ I-_' Subsurface Sewagy 'Oisoosal System Form'- Not for Voluntary Assessment's.
r ,_= 76 WASHINGTON AVE.
.Property Address
JOE SHAY
Owner Owners Name
information is required for every HYANNIS PORT MA 02647 8/24/2009
page.. City/Town. State Zip Code Date of Inspection
D. System Information (cunt.)
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc:):` "
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If-SAS not.located,.explain why:-
Type..
leeching,•pits number::
.10
. ° leaching chambers i number: ;
'.leaching-`galleries °. number ,
❑ -leaching trenches number,length:.
-� leachang_fields n_urnber;-_dimensions
overflo\ni cesspool" number: '
0 innovative/alternative;system
Type/name of technology:
Comments (note condition of'soil, signs of hydraulic failure, level of ponding„_damp soil-condition of
vegetation,:;etc ):
LEACHING IS 10 INFILTRATORS. 39'X20.5'X2'. PROB AND TEST HOLE ABOVE'AND BESIDE.
:LEACHING ARE DRY WITH NO SIGN OF OVER LOADING.
76 WASHINGTON AVE HYANNISPORTdcc•03/08 e Title 5 Official Inspection Form:Subsurface Savage Disposal System•Page 12 of 15
Commonwealth of Filassachusetis
��Z
Title Off tdal In spection, Form:
C✓i\
Subsurface SeYlage Diis;p�osal System Form Not for.Voluntary Assessments
; = 76 WASHINGTON AVE`
Property Address'
JOE SHAY
Owner Owner's Name
information i e
required for every HYANNIS PORT MA 02647 8/24/2009
page. City/Town State Zip Code Date of Inspection
D.. System Information (cont.)'
Cesspools(cesspool must be pumped aspart of inspection) (locate on site plan);
Number and configuration
Depth—'top-of liquid to inlet invert.
-- - -- Depth,of.solids layer
Depth of scum layer,
Dimensions of,cesspoo[
Matdrials of construction
Indication of groundwater inflow 11Yes 0 No `
Comments (note condition:of soil,_signs of hydraulic failure, level of ponding,condition of vegetation -
etc.)
r ,
• :
PrJvv-(locate on site plan):. = ---- _
Materials-of construction: . .
a
Dimensions
Depth.of solids
Comments (note condition'of.soil;.signs,of hydraulic failure, level of ponding condition iof�vegetation, `
I
7o WASHINGTON AVE HYANNISPORT.doc.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System^Page 13 of 15
5
x� o �11�e1t11 l���asaachu-s� t
7 CI � t Form,
r �3U 1as�t�aya sallijaa 03�C��' 1 Syztamn +omm - of icr'Voluntar`� n c cnts.
J ,
=. . -
76 \IAIAS;HlNli3T�0N AVE
Property Address.:
J 0 E SHAY
Owner Owner's Name
information is 1-'1`(Al NIS PORT INIA 02e47 ;;' 8/24/2009
required for every
page. City/Tovvn State Zip Code Date of inspection
D' Syz lnfoo affon (cunt.) ,
Sketch Of SeNJvage Disposal System: °rovide a sketch Of the sewage disposal system including tie
to at,least Nvo,permanent reference`landmarks.or benchmarks'. Locate all wells within 100 feet.
Locate�nihEre public viiater suppy enters,the:building.
TV
u.
• 3 � 4
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a � �� .�. �=,=ram• ., � 's
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v k i �0 r 4 Y. L� •s J l er�'. ^4 — �. I M �. �.e
76 WASHINGTON AVE HYANNISPORT.dec•.03108 Title 5 Official Inspecticn Fcrm:Subsurface Sewage Dispcsal System Page 14 of 15
.� . Commonwealth of Massachusetts
�1 ffle da* ' inspection Forte .
_f ME 1, Subsurface Se�jage Disposal System Form. Not,for Voluntary Assessments
76 WASHINGTON AVE
,.,f. Property Address
JOE SHAY
Owner Owner's Name
information is required for every HYANNIS PORT. MA 02647 8/24/2009
page. City/Town - State Zip Code Date of Inspection
Da System Information (coot.)
Site Exam:
Check Slope NONE
Surface water .NONE .
❑.-- Check cellar - .3/4
❑ Shallow wells NONE
Estimated depth to high ground water. 10+feet
Please indicate all methods used to determine the.high ground water elevation: a ,.
x❑ Obtained from system design plans on record a
If checked, date.of design plan reviewed:
5/8/97
Date
Obse'rved'site,(abutting property/observation hole within 15.0 feet of SAS) -"
❑° ,Checked.with-local-Board of Health -'explain:
- .. :.4 _
❑. .• Checked with local excavators, installers-(attach'documentation)' '
❑-----Accessed=USES-database=:explain
,
You must describe how you established the high ground water elevation:
TEST HOLE PER PLAN
10' NO WATER
76 WASI-IINGTON AVE HYANNISPORT.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page15 of 15
y.:
r
TOWN
� OF BARNSTABLE
LOCATION 7&W-451i i ajA�®u Ave- SE WAGE # .3
VILLAGE m � ASSESSOR'S MAP LOT - 77
INSTALLER'S NAME fa PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY 4606 6
LEACHING FACILITY:(type(fv `��oLf/'i4�°%CM size) J 2,0S")(-Z'`
NO.OF-BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER,
DATB PERMIT ISSUED: - 1 7
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
r .
r
• r
O P
�r f ,f ,,�• O
E. 55
No. w Fee
THE-tOMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpphratfon for ;Dtopaal *pgtem Construction Vermtt
Application for a Permit to Construct( )Repair(,/S Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.76 �i�,f}J %✓!f� ��� Owner's ame,Address d Tel.No. y�a 9f ft
Assessor's Map/Parcel / a.w pt(sPO v`T Yoe S/1 ow
(e
Installer's Name,Add fs*Vgt.:MC0 Designer's Name,Address and Tel.No.
350 Main Street bf•1'l'1 Cri?, � �� f
We Yarmouth, MA 02673
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 17te d gallons per day. Calculated daily flow �'IO gallons.
Plan Date 6%/A-9 7 Number of sheets % Revision Date y/!4
Title C-ife + c.S2.0),a G t A(AAJ
Size of Septic Tank v?,o&,o Type of S.A.S. 21) i/fls+' J-r 3 7 is S o x a
Description of Soil a 1' 041AA1
Nature of Repairs or Alterations(Answer when applicable) 4Ur 1 10/AA
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of al
Signed -0Date
Application Approved by Date '
Application Disapproved for the following reasons
Permit No. 919 ' 4,, V Date Issued ¢
—�
21
No. f' '. se�y Fee S6
M F Entered in computer: j
� POMMONWEALTH OF MASSACHUSE TS
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,; MASSACHUSETTS `!
2pplication for ;Diopozal *pgtem Construction Permit
Application for a Permit to Construct( )Repair(oe S Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.,�j W h%>> /r��.� Owner's ame,Address and Tel.No. Y tv o.
l-ky 0-14%cs.P��� ve
Assessor's Map/Parcel ^� ..�► a � � / j
�( / n f G Ova li!ju ro. Q
Installer's Name,Addre� Designer's Name,Address and Tel.No.
350 Main Street 39
W. Yarmouth, MA 02673
Type of Building:
Dwelling No.of Bedrooms �- Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons t Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets / Revision Date
t Title R i I Q_ + S-eu1.dr_ NAAJ
- Size of Septic Tank Type of S.A.S. .3 to if l A -1e d'f 3 J1 tX a o sc A
Description of Soil pe r .014�✓
Nature of Repairs or Alterations(Answer when applicable) 1,4 Al
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of.liealth.
Signed Date ( • 4'9 7
Application Approved by Date �'
Application Disapproved for the following reasons
Permit No. 19 Date Issued:"Y /.,=_ V
4V # < .
———————————————————————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
!i BARNSTABLE MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( ✓f Upgraded( )
Abandoned( )by or,4A"e,o
at 26 47" Ave 1.4 i,f has been constructed in accordance
with the provisions of Title 5 and the for Disposal System C"onstruction Permit No. - 23 dated 6 `y` 1�2 .
Installer Designer
The issuance of this permit/hall n t-b-e� cons try d.as a guarantee that the system will function as designed.
Date_ ' / Inspector
----------------------------------------
No._ ,2_ ,;z 73 y Fee �V "
F
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Oigpozal *p�tem Construction Permit
Permission is hereby granted to Construct( //)Repair Upgrade( )Abandon( )
System located.at 7�� /'", f
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
r Provided:Construction must be completed within three years of the date of this permit.
Date: Approved by.
1
TOWN OF BARNSTABLE
` � SEWAGE # w 3
LOCATION -71P
VILLAGE N) ASSESSOR'S MAP 6>! LOT - 77
INSTALLER'S NAME 6z PHONE NO. A & B CANCO
775-6�
SEPTIC TANK CAPACITY �Y,")
d� GRL
1/N� Ms zze) XZLEACHING FACILITY:(type / ,�d�
r,✓�g/`,rloMe. weev ,F•�/wCs� 3
NO. OF $EDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER A
DATE PERMIT ISSUED:_
DATE COMPLIANCE ISSUED:
No
VARIANCE GRANTED: Yes
i
r
r
1
syITH s,?, ASSESSORS MAP: 287
PARCEL: 96 TEST HOLE LOGS NOTES:
39 1. VERTICAL DATUM ASSUMED FROM QUAD (NGVD
Locus FLOOD ZONE: C ENGINEER: THOMAS McLELLAN, P E. 2. MUNICAPAL WATER IS AVAILABLE.
WITNESS: GERRY DUNNING 3. SCHEDULE 40 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM.
DATE: 5-8-97
d� z0 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10
PERCOLATION RATE: < 2 MIN/IN
As�VGTo �' 4` LOADING SPECIFICATIONS.
3'
5. PIPE PITCH = 114" PER FOOT, (UNLESS NOTED OTHERWISE).
I ING �� TH-1 220 2'TH-2
HYANNIS 6. FIRST OF PIPE OUT OF D-BOX TO BE SET LEVEL.
HARBOR LEACH AREA DETAIL FILL ELEV 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE
r
12" 21.0 USE OF A GARBAGE DISPOSAL.
8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE
Cl HORIZON
LOCATION MAP SILT LOAM STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL
60" IOYR 612 r••0 HEALTH REGULATIONS.
LOT 3 BENCHMARK TOP of 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR
8106 + S.F. CONCRETE BOUND 21. 1
-z3 ELEV 22 3a 22 MEDIOUM SAND TO CONSTRUCTION.
_ ltv 5Y 7/4 10. GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO
EXCEED 3.0.
60. 00 4
1 6; IEIVCE LINE' 1 �, 11. ALL UNSUITABLE SOIL (SILT LOAM, APPROX. 5' DEEP) WITHIN 5' OF
1 fa rH-1 120" 12D PROPOSED LEACHING AREA IS TO BE REMOVED AND REPLACED WITH
CLEAN MEDIUM SAND.
1 10, NO GROUNDWATER ENCOUNTERED
ytE, � 12. EXISTING CESS POOLS ARE TO BE PUMPED AND FILLED WITH SAND
\ 21. 1 OR REMOVED.
SEPTIC SYST EM DESIGN 13. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW.
s7 15. fa JfiN 1 FLOW ESTIMATE:
J -Z- BEDROOMS AT 110 GAL/DAY/BEDROOM = 770 GAL/DAY
/ i w SEPTIC TANK:
FBiVCB
/ 770 CAL/DAY x 2 DAYS = 1540 GAL
' 1 � EXISTING USE 2000 GALLON SEPTIC TANK
R�Jf
� 7 BED
I P►ELLtNG J / 20. 9 LEACHING AREA:
J 1st FLwh L'LLy_23B /
h 21 USE 10 INFILTRATORS (MAXIMIZER CHAMBERS)
J J / Q) WITH 4' OF STONE BETWEEN AND AT ENDS AND 3'
23 OF STONE AROUND SIDES (SEE DETAIL THIS SHEET)
EXISTING /
tM'E ' _•21s cvw SIDE AREA (59.5)2 x 2 = 238 SF (.74) _ 176 GAL/DAY
BOTTOM AREA: _39' x 20.5' = 800 SF (74) _ 592 GAL/DAY
E'E'NC 1 CAPACITY = 768 GAL/DAY
E a
SEPTIC SYSTEM SECTION
2" PEASTONE
COVERS WITHIN 12" OF
CPj, / / 0. 1 23.8 ONE FINISHED
NSPEN COVER 314" - 1 112"
WALK FIRST FLOOR �r0 BE WITHIN 6" of GRADE) WASHED STONE
-----zz 1
- 20. 1 ELEV.= 20.0
20.4
e E ELEV. o o
-...... REM
20.65 2000 G,qL ID-BOX m 17.5
20.17
WA,Sj�jNG?,�N „ELEV. SEPTIC TANK 20.34 " OF ELEV. 4 30 4 ELEV.
VEN 21.5 (6 OF STONE UNDER OR ELEV. STONE ME 20.5' x 39' -�
ELEV. MECHANICALLY COMPACTED) UNDER) 10 INFILTRATORS (MAXIMIZER CHAMBERS
KEY: EXISTING 19.5 )
(EXISTING) TEE SIZES: WITH 4' OF STONE BETWEEN AND AT ENDS
EXISTING CONTOUR: - „ GAS BAFFLE AND 3' OF STONE AROUND SIDES
INLET 6 UP, 13 DOWN AT OUTLET TEE ELEV.
(39' x 20.5' x 2' DEEP)
PROPOSED CONTOUR: ••••••••••••••••••••••••••••• OUTLET: 6" UP, 14" DOWN
EXISTING SPOT ELEVATION: 25.5
PROPOSED SPOT ELEVATION: 25
TEST HOLE: REQUIRED TITLE FIVE VARIANCES SITE AND SEWAGE PLAN
UTILITY POLE: -Q- APPROVED BY: DATE:
FENCE LINE: 1. SECTION 15211 (1). LEACH AREA TO BE LESS THAN fa FROM PROPERTY LINE, (6'). LOCATION
' HYDRANT: -�-
2 SECTION 152H (1). LEACH AREA TO BE LESS THAN 2a FROM BULKHEAD, (15'). 76 WASHINGTON AVENUE
RETAINING WALL: ® g of
TREE: 3. SECTION 15211 (1). SEPTIC TANK TO BE LESS THAN 10' FROM PROPERTY LINE, (8'). ��' r�� y x'`' "
kiEUM HYANNI SPORT, MA
4 SECTION 15211 (1): SEPTIC TANK TO BE LESS THAN fa FROM BULKHEAD, (8'). CIVIL
v' N , 1 DM 3647A PREPARED FOR
SYSTEM HAS BEEN DESIGNED TO MAXIMUM FEASIBLE COMPLIANCEOj lea-
( )
DEMAREST-McLELLAN ENGINEERING
24 SCHOOL STREET P.O. BOX 463 C 1 �
5.,�� ' A.B. CANCO SHAY
WEST DENNIS, MASSACHUSETTS 02670 " = 20'
PHONE & FAX : (508) 398-7710 �� � SCALE: 1 DATE: 5116197
DM # _97-016 (D24F11) REFERENCE: PLAN BOOK 115 PAGE 129
THOMAS McLELLAN, P.E. JOHN Z. DEMAREST JR., P.L.S.
i